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Fiscal NoteS.B. 96 4th Sub. (Pumpkin)2019 General SessionMedicaid Expansion Adjustmentsby Christensen, A. (Dunnigan, James.)

General, Education, and Uniform School Funds JR4-5-101

Ongoing One-time TotalNet GF/EF/USF (rev.-exp.) $45,300,000 $(94,536,100) $(49,236,100)

State Government UCA 36-12-13(2)(b)

Revenues FY 2019 FY 2020 FY 2021

Federal Funds $0 $(629,600,000) $(629,600,000)

Federal Funds, One-Time $(103,200,000) $222,963,900 $215,900,000

Dedicated Credits $(12,000,000) $(90,200,000) $(95,500,000)

Medicaid Expansion Fund $53,020,000 $116,000,000 $108,000,000

Total Revenues $(62,180,000) $(380,836,100) $(401,200,000)

Enactment of this bill deposits the following amounts in the Medicaid Expansion Fund: $12 million inFY 2019, $89 million in FY 2020, and $106 million ongoing in FY 2024 from the previously approved0.15% sales tax increment; $38.2 million one-time in FY 2019 and $15 million ongoing beginning inFY 2020 from the General Fund; $1,620,000 in FY 2019 and $12,000,000 in FY 2020 from hospitalassessments; and $1.2 million from the Medicaid Restricted Account in FY 2019. Compared to currentlaw, it could forgo federal funds of ($103) million in FY 2019, ($407) million in FY 2020, and ($630)million ongoing in FY 2024 for the Medicaid program. Finally, it may reduce dedicated credits by: ($12)million in FY 2019, ($89) million in FY 2020, and ($106) million ongoing in FY 2024 from sales tax nolonger used as dedicated credits and ($1.2) million in FY 2020 and ($6.6 million) ongoing beginningin FY 2024 for less money from counties for mental health and substance abuse services. If the Stateimplements a qualified Medicaid expansion, then in addition to the impacts listed above the Statewould receive more federal funds of $213 million in FY 2021 and $303 million ongoing in FY 2024.

Expenditures FY 2019 FY 2020 FY 2021

General Fund $0 $(45,300,000) $(45,300,000)

General Fund, One-Time $29,600,000 $64,936,100 $43,400,000

Federal Funds $0 $(629,600,000) $(629,600,000)

Federal Funds, One-Time $(103,200,000) $222,963,900 $215,900,000

Dedicated Credits $(16,500,000) $(114,400,000) $(126,900,000)

Medicaid Expansion Fund $30,100,000 $181,400,000 $112,500,000

Total Expenditures $(60,000,000) $(320,000,000) $(430,000,000)

This bill appropriates $4.6 million one-time and $15 million ongoing beginning in FY 2020 from theGeneral Fund, plus $18 million one-time from the General Fund Restricted - Medicaid RestrictedAccount for expanded Medicaid coverage. Enacting this bill could save the state an estimated ($60)million from all sources in FY 2019, ($320) million from all sources in FY 2020 and ($690) million

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ongoing from all sources in FY 2024 for expanded Medicaid by replacing current law with a Medicaidwaiver. With regard to General Fund costs, because the bill accesses excess sales tax collectionsin FY 2019 and FY 2020 and requires a waiver that would reduce costs in years beyond FY 2020,when compared with current law and assuming waivers are approved, this bill could cost the state$29.6 million from the General Fund in FY 2019 and $19.6 million from the General Fund in FY 2020,then save the state ($45.3) million ongoing from the General Fund beginning in FY 2024. Additionally,by serving 48,000 fewer individuals on Medicaid, less state match will be required of ($42.3) millionongoing beginning in FY 2024. If the State implements a qualified Medicaid expansion, then in additionto the impacts listed above the State would spend more total funds of $240 million in FY 2021 and$340 million ongoing beginning in FY 2024. This would come at a cost to the State General Fund of$3.8 million in FY 2021 and $4.2 million ongoing in FY 2024. The total additional state match requiredwould be $27.5 million in FY 2021 and $37.4 million ongoing in FY 2024.

FY 2019 FY 2020 FY 2021

Net All Funds $(2,180,000) $(60,836,100) $28,800,000

Local Government UCA 36-12-13(2)(c)

Hospitals owned by a non-state government entity could pay a new inpatient hospital assessment of$16,200 in FY 2019 and $120,000 in FY 2020. If the State implements a qualified Medicaid expansion,then in addition to the impacts listed above hospitals owned by a non-state government entity couldpay up to $145,300 in FY 2021 and $70,600 ongoing beginning in FY 2024 in additional inpatienthospital assessments if state costs exceed revenues available in the Medicaid Expansion Fund.

Individuals & Businesses UCA 36-12-13(2)(d)

Under provisions enacted by this bill certain privately-owned hospitals would pay an additionalinpatient hospital assessment totaling $1,117,800 in FY 2019 and $8,280,000 in FY 2020. TheUniversity of Utah teaching hospital would pay $486,000 in FY 2019 and $3,600,000 in FY 2020. Themaximum permitted ongoing hospital assessment is reduced under this bill by $10 million dollars.Compared to current law, approximately 48,000 recipients would avoid Medicaid co-pays and otherrelated costs beginning in FY 2020 and also forgo expanded services. If the State implements aqualified Medicaid expansion, then in addition to the impacts listed above certain privately-ownedhospitals could pay up to $10,022,500 in FY 2021 and $4,868,200 ongoing beginning in FY 2024 aswell as the University of Utah teaching hospital paying up to $4,357,700 in FY 2021 and $2,116,700ongoing beginning in FY 2024 in additional inpatient hospital assessments if state costs exceedrevenues available in the Medicaid Expansion Fund. Approximately 45,000 recipients would payMedicaid co-pays and other related costs beginning in FY 2021 in exchange for expanded services.

Regulatory Impact UCA 36-12-13(2)(e)

Enactment of this legislation likely will not change the regulatory burden for Utah residents orbusinesses.

Performance Note JR4-2-404

No performance note required for this bill

Notes on NotesFiscal notes estimate the direct costs or revenues of enacting a bill. The Legislature uses them to balance the budget. They do not measure a bill'sbenefits or non-fiscal impacts like opportunity costs, wait times, or inconvenience. A fiscal note is not an appropriation. The Legislature decidesappropriations separately.